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I Thought We Weren’t Supposed to Do That?

Dr. Fisher is assistant professor of medicine and medical ethics, Baylor College of Medicine, Ben Taub General Hospital, Section of General Medicine, Houston, Texas; (joslyn@bcm.edu).

Lily, a bright, compassionate medical student deliberating on choice of medical specialty, asked me if I could tell her about one of my most meaningful patient experiences. I reflected for a while and then began to describe attending a patient’s funeral. In a surprised tone, she interrupted with, “But I thought we weren’t supposed to do that—go to a patient’s funeral? Isn’t that getting too close, too personal?”

It has been many years since I attended my first patient funeral, yet I still recall being afraid of the experience itself, not knowing what to expect—a different culture, religion, part of town. It was loud, with exuberant singing, praying. The congregants raised the roof with their energy. When I got home, I told my partner—that’s how I want to go out of this world. Wow! They made it joyous, not the depressing ceremony that I had anticipated.

On my drive to a subsequent funeral, I worried about what the family would think about me. I had seen Ms. Tolly in my primary care clinic for years. While I was not involved with her inpatient care at the time of her death from cancer, would the family be accusatory—with thoughts that perhaps I had missed an opportunity to diagnose their mother earlier? Would they be angry that I was not at the bedside when she died? I arrived at the funeral home, took a deep breath, and wished I had a companion to stand by me. My patient’s sister and children greeted me kindly. My fears eased, and I felt comforted as the family expressed genuine appreciation for the years of medical care that I had provided to Ms. Tolly.

A few days after my encounter with Lily, one of my dearest patients, Ms. Sanchez, passed away. I was extremely saddened by her death, though not surprised. She had many chronic health problems and had suffered a life-threatening stroke several weeks earlier. One of Ms. Sanchez’s grandchildren contacted me to let me know about the funeral on Saturday. I had many commitments, in particular to spend some quality time with my young children. I decided that I would go to the funeral briefly, express my condolences, and leave.

After crying most of the way to the funeral, I recognized that I was using my family somewhat as an excuse—I was genuinely sad and reluctant to end my relationship with Ms. Sanchez. I had visited her in the hospital prior to her discharge to a long-term care facility. Now I was going to finally meet the family about whom I had heard much and seen many photos. I recognized her son Pepe immediately, wearing his Hawaiian shirt and lei, and Charlie, her grandson, who had recently graduated. Here was the family that she so loved and that loved her. Multiple family members recognized me as her doctor, hugged me warmly, and exchanged stories. For the first hour of the funeral, family members recounted her life, described how her compassion had affected everyone there, and presented a slide show about her.

Not one person mentioned her many illnesses and how, despite these conditions, she had accomplished so much. The ceremony was truly enlightening, giving me a new perspective of my patient outside of the public hospital and renewing my awareness of all my patients as individuals—who live full lives with illness. I felt able to complete my farewell to Ms. Sanchez while opening doors for enhanced relationships with other patients.

I appreciate my patients for continuing to teach me beyond the clinic—to be less afraid of death itself, to understand that a patient’s death is not synonymous with failure or culpability, and maybe most importantly to recognize that we need closure with some of our patients. So Lily, I think it is okay—you can attend a patient’s funeral. It is part of caring for your patient and caring for yourself.

Joslyn W. Fisher, MD

Dr. Fisher is assistant professor of medicine and medical ethics, Baylor College of Medicine, Ben Taub General Hospital, Section of General Medicine, Houston, Texas; (joslyn@bcm.edu).